CHILD MEDULLOBLASTOMA

ALTERNATE NAMES

Anaplastic Medulloblastoma; Classic Medulloblastoma; Desmoplastic Medulloblastoma; Embryonal Neuroepithelial Tumor; Large-Cell Mesdulloblastoma; MBEN; Medulloblastoma with Extensive Nodularity; Nodular Medulloblastoma; Primitive Neuroectodermal Tumor of the Poterior Fossa

DESCRIPTION

Medulloblastoma is a rare primary central nervous system (CNS) tumor that starts in the cerebellum, the part of the brain that controls muscle coordination, balance, and movement. Medulloblastomas are cancerous and fast-growing. They often spread to other areas of the CNS through cerebrospinal fluid (CSF). Rarely, medulloblastomas can spread outside the CNS to the bones or the lymphatic system.

Medulloblastoma is primarily a childhood disease that mostly affects children and teens under the age of 16. Though rarer in older individuals, it can occur in adults as well. Medulloblastoma in adults is usually diagnosed between the ages of 20 and 44.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: The diagnosis of a medulloblastoma is made by:

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  Physical examination;

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  Neurological examination;

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  Magnetic resonance imaging (MRI);

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  Computed tomography (CT) scan;

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  Positron emission tomography (PET) scan;

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  Biopsy; and

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  Lumbar puncture (spinal tap) may be performed to obtain CSF to search for cancer cells or tumor markers.

Physical findings: Symptoms of medulloblastoma depend on the tumor’s size and location, the child’s age, and stage of development. Symptoms may include:

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  Headaches which are often worse in the morning and get better during the day;

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  Nausea;

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  Vomiting;

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  Feeling tired or having changes in activity level;

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  Problems with motor skills, such as clumsiness or poor handwriting;

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  Tilting the head to one side;

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  Double vision (diplopia);

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  Rapid, jerky eye movements (nystagmus);

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  Facial weakness;

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  Loss of balance; and

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  Seizures.

If the tumor has spread to the spinal cord, symptoms may include:

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  Back pain;

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  Difficulty walking; and

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  Inability to control bladder and bowel functions.

ICD-9: 191.6

ICD-10: C71.6

PROGRESSION

Survival rates are dependent upon the child’s age, features of the tumor, how much the tumor has spread, and response to treatment. About 60-65% of children with high risk medulloblastomas live for five years or more. With multimodal treatment and appropriate risk stratification, the long-term survival rate improves to 70–80%. Children younger than age three often have lower survival rates because options for safe and effective treatment may be limited.

TREATMENT

Surgery alone does not cure this type of cancer. Chemotherapy and radiation are often used in combination with surgery.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

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  Clinical history and examination that describes the diagnostic features of the impairment;

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  Pathology/biopsy report of the cancer; and

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  If available, spinal tap results.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.13 A 2

113.13 B

Medulloblastoma meets the criteria in listings 13.13 A 2 or 113.13 B upon confirmed diagnosis.

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